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Context Lower extremity bone stress injuries (BSIs) place a significant burden on the health and readiness of the US Armed Forces. Objective To determine if preinjury baseline performance on an expanded and automated 22-item version of the Landing Error Scoring System (LESS-22) was associated with the incidence of BSIs in a military training population. Design Prospective cohort study. Setting US Military Academy at West Point, NY. Patients or Other Participants A total of 2235 incoming cadets (510 females [22.8%]). Main Outcome Measure(s) Multivariable Poisson regression models were used to produce adjusted incidence rate ratios (IRRs) to quantify the association between preinjury LESS scores and BSI incidence rate during follow-up and were adjusted for pertinent risk factors. Risk factors were included as covariates in the final model if the 95% CI for the crude IRR did not contain 1.00. Results A total of 54 BSIs occurred during the study period, resulting in an overall incidence rate of 0.07 BSI per 1000 person-days (95% CI = 0.05, 0.09). The mean number of exposure days was 345.4 ± 61.12 (range = 3–368 days). The final model was adjusted for sex and body mass index and yielded an adjusted IRR for a LESS-22 score of 1.06 (95% CI = 1.002, 1.13; P = .04), indicating that each additional LESS error documented at baseline was associated with a 6.0% increase in the incidence rate of BSI during the follow-up period. In addition, 6 individual LESS-22 items, including 2 newly added items, were significantly associated with the BSI incidence. Conclusions We provided evidence that performance on the expanded and automated version of the LESS was associated with the BSI incidence in a military training population. The automated LESS-22 may be a scalable solution for screening military training populations for BSI risk.

Automated Landing Error Scoring System Performance and the Risk of Bone Stress Injury in Military Trainees